Brain Surgery is Scheduled

Graham Update Day 62 (8/9/14)

It's hard to believe that 2 months ago today Graham's head was run over and crushed by an SUV.  He has come so far, and continues to get a little bit better every day.  He does have another brain surgery coming up, and we are hopeful that he will be able to maintain his momentum after the operation.  In this update I'll discuss some of the progress that he is making, as well as discuss the surgery and one possible alternative to opening up Graham's skull again which may arise....

In terms of Graham's therapy, he is making huge strides, especially with his short-term memory.  10 days ago he was really "10-second-Tommy," meaning he would pretty much forget anything that happened even a short while before.  With some drilling and pressure he would remember things, but a question as simple as "what did you do in gym (that's what we call physical therapy) five minutes ago" was impossible for him to answer.  He didn't remember his therapists names, and unless you had really drilled it into him, he certainly couldn't remember anything from the day before.

All that has changed now.  He knows his therapists by name.  He remembers the name of one of his little friends and fellow-patients here.  Today he came back from occupational therapy and said "Dad!  We had a water gun war!"  It's very relieving to see him recover in that respect, as his short term memory, probably more than anything else at this point, will go a long way towards him returning to and succeeding in school.  Another good sign?  His reaction-time and hand-eye coordination, captured in this picture below.

Graham is making great strides physically as well. When Graham first arrived at Cook Children's, he was on orders to not walk at all unless someone was holding on to the gate-belt around his waste.  Last week that changed - he is now free to walk around simply holding somebody's hand.  And were it not for the impending surgery, Graham's physical therapist said she would release him for "standby" walking, meaning he would be free to walk completely unassisted as long as someone was close by.  He can bend over and pick things up off the floor without falling - another huge improvement.

Graham senses the improvement as well.  For a while he would talk about how he was in the hospital "to find get his balance back."  He was reluctant to walk without help.  Now he is constantly trying to release our hand when walking, and occasionally when he gets excited he even tries to run.

The big mountain ahead of us now is Graham's next brain surgery.  He is leaking fluid into his "dirty" sphenoid sinus (pictured below), which means he is at great risk for bacteria to find its way from the sphenoid sinus back to his brain, causing meningitis.  So they are going in to plug the hole from the base of his skull into his sinus.  I'm no radiologist, but I think you can even see the hole in the image of Graham's brain below. (Doctors feel free to laugh at me if I am wrong)

Dr. Braga, who did Graham's first surgery, will perform this one as well.  The neurosurgeon here, Dr. Honeycutt (awesome man), said that there are certain advantages to Dr. Braga doing it, so that's what we will do.  He will open Graham's skull along his existing scar-line - a wave-like incision from ear to ear across the top of Graham's head.  He will then remove the top of Graham's skull, push on the brain enough to expose the leak, and plug it up - likely with a plate.

It will be significantly more "invasive" that Graham's first surgery, so naturally we are praying extra hard that all goes well.  But there is a very small chance that the surgery won't even happen.  I'll explain:

When Dr. Braga first looked at Graham's CT Scans and MRIs from here at cook, he agreed with Dr. Honeycutt that the surgery needed to be done and scheduled it.  In looking back at the images and in discussing it with his colleagues, however, he decided there was a chance that maybe they would not need to open up Graham's skull at all, but that perhaps an Ear/Nose/Throat (ENT) surgeon could plug the leak by going in through the nose lapriscopically.  He said there used to be a doctor at Children's who he thinks could do it, but that doctor is not there anymore.  So Dr. Braga and the other brain surgeons in his group are going to see if there is someone else in DFW who feels they would have a high probability of success in plugging Graham's leak lapriscopically.  If they do, then we will start consulting with THAT surgeon and will inevitably have to transfer to a different hospital for the surgery, and then come back to Cook Children's again for rehab.  I discussed this with my sister, and she brought up a great point - what if there isn't someone who could do it in DFW, but there is in Houston?  or New York?  I know from talking to the EMT who brought Graham from Children's to Cook that they transport internationally, so perhaps there is a doctor out there somewhere who could perform the operation with a high likelihood of success. If there is, I know we can get him there.  So if any of you know any ENT surgeon-gurus who want to look at some CT scans and MRIs, feel free to let me know.  =)

So unless someone comes forth from the woodwork and says "I can plug up that leak in the base of Graham's skull by going in through his nose!" surgery will be Wednesday. Thank you all for your prayers - we know it is a combination of expert medicine and a loving Heavenly Father who have brought Graham this far. On Wednesday Graham faces his most invasive and risky surgery yet , so we will be praying for steady hands and no complications.